The Australian government has approved a 4.41% increase in private health insurance premiums starting this April. This is the largest hike in almost ten years. Many Australians are worried if the insurance is still worthwhile, with rising interest rates and cost-of-living pressures. Elizabeth Deveny, chief executive of the Consumers Health Forum, said, "If premiums are rising faster than wages and inflation, people are asking: are we getting better protection, clearer coverage, and fewer surprise bills?" She added, "Right now, many consumers would say no." About a decade ago, investigations revealed many problems in private health insurance, including complexity and poor value. Government efforts like labeling policies as gold, silver, bronze, or basic and reducing junk products have not fixed these issues. Consumers still face confusion, limited coverage, and surprise costs. Health economist Prof Francesco Paolucci pointed out that government incentives pushing people to buy private insurance have not changed in over ten years. These include the Medicare levy surcharge, lifetime health cover, and private health insurance rebates. These incentives mostly force people to buy insurance to avoid tax penalties instead of because it meets their health needs. The lifetime health cover surcharge adds 2% extra each year if someone delays getting insurance after age 31. The Medicare levy surcharge is an extra tax for those earning over $101,000 without private cover. The rebate reduces premiums based on age and income. However, Paolucci says these policies do not control rising premiums well and need updating. Professor Yuting Zhang from the University of Melbourne noted that the government spends billions annually on the private health insurance rebate. While this may ease pressure on public hospitals, many privately insured patients still use public services due to limited insurance coverage. She suggests subsidies should better target low-income groups or be used elsewhere in healthcare. Zhang also highlighted efficiency issues, with about 15% of premiums now going to administration and costs, up from around 10%. Some experts argue for scrapping private health insurance and focusing on a stronger universal Medicare system. Though Zhang and Paolucci find this unlikely due to the mixed system, Deveny said, "Whether we keep private health insurance or redesign it is a legitimate question." She added, "People have lost confidence in the value of it. If the insurance system is going to exist, it has to work for the people who are paying for it. Insurance should reduce risk and make people feel safe when they’re sick – not create a second layer of risk and anxiety." If premiums keep rising, the debate may shift from affordability to whether private health insurance deserves government support at all. For stories on private health insurance, contact melissa.davey@theguardian.com – Melissa Davey, Guardian Australia’s medical editor.